Esophageal Adenocarcinoma Methods and Protocols

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Alfred K. Lam (ed.), Esophageal Adenocarcinoma: Methods and Protocols, Methods in Molecular Biology, vol. 1756,
https://doi.org/10.1007/978-1-4939-7734-5_8, © Springer Science+Business Media, LLC 2018

Chapter 8

Processing of Surgical Specimen (Esophagogastrectomy)

for Esophageal Adenocarcinoma

Benjamin M. Allanson and M. Priyanthi Kumarasinghe

Abstract

An esophagogastrectomy is a surgical procedure that is performed for treatment of confirmed localized
esophageal and esophagogastric junction adenocarcinoma. Proper macroscopic assessment and cut-up
technique is essential to ensure that the overall assessment is correct and reproducible. Here, we describe
a standard for macroscopic assessment and dissection to be used for routine handling of esophagogastrec-
tomy specimens in the clinical laboratory.

Key words Esophageal adenocarcinoma, Macroscopic, Handling, Cut up, Esophagogastrectomy,

Esophagectomy

1 Introduction

Pathological assessment of tissue is the gold standard for diagnosis

and staging of neoplasia and provides key prognostic information

for clinical management. Proper macroscopic assessment and cut-

up technique is essential to ensure that the overall diagnosis is cor-

rect and reproducible. Incorrect technique can lead to errors in the

microscopic interpretation.

An esophagogastrectomy is a surgical procedure that is per-

formed for confirmed localized invasive malignancy of the distal

esophagus and gastro-esophageal junction (see Chapter 4 ). The

specimen normally includes distal esophagus, gastro-esophageal

junction, and proximal stomach. A common practice for locally

advanced tumors is to perform this procedure after a combina-

tion of neoadjuvant chemotherapy and radiotherapy. This speci-

men is assessed histopathologically to confirm the biopsy

diagnosis, identify the depth of local invasion, the degree of dif-

ferentiation, presence or absence of lymphovascular invasion, the

involvement of local lymph nodes, the margin status, and assess

the response to preoperative treatment [ 1 – 4 ]. These features